Acute kidney injury in COVID‐19: Identification of risk factors and potential biomarkers of disease in a large UK cohort

Phillips, Thomas, Stammers, Matt, Leggatt, Gary, Bonfield, Becky, Fraser, Simon, Armstrong, Kirsten and Veighey, Kristin (2021) Acute kidney injury in COVID‐19: Identification of risk factors and potential biomarkers of disease in a large UK cohort. Nephrology, 26 (5), 420-431. (doi:10.1111/nep.13847).

Abstract

Background: COVID‐19 is associated with increased risk of acute kidney injury (AKI). Risk factors and biomarkers linked to AKI have now been recognized by national guidelines in the United Kingdom. This analysis aims to validate and expand the comorbidities and biomarkers associated with the presence and severity of AKI in these patients.
Methods: Data were extracted via structured query language for patients with COVID‐19 at University Hospital Southampton between 1 March and 10 June 2020. Demographics, comorbidities, common biomarkers and AKI stage within 48 hours of admission, peak during admission and the last measurement prior to patient outcome (discharge or death) were collected and statistically analysed.
Results: Six hundred and thirty‐two COVID‐19 positive patients were admitted during this period; 34.2% had an AKI during their entire admission, 20.3% had AKI stage 1, 8.5% stage 2 and 5.4% stage 3. This was higher when compared with data from the same period in 2019. AKI carried an increased risk of death, 50.0% vs 21.1% (P = <.001). AKI stage was significantly associated with age over 65, diabetes, heart failure, peripheral vascular disease, haematological malignancy, hypertension, respiratory rate, albumin, C‐reactive protein (CRP), d‐dimer, ferritin, high‐sensitivity troponin‐I, neutrophil count, total white cell counts, National Early Warning Score‐2 (NEWS‐2), Charlson comorbidity index and alanine‐aminotransferase. COVID‐19 specific treatment, including dexamethasone, reduced discharge creatinine.
Conclusion: COVID‐19 increases the risk of AKI and this kidney injury may be responsive to treatment. This analysis identified that AKI is associated with both previously described and new comorbidities and biomarkers.

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Contributors

Author: Gary Leggatt

Author: Simon Fraser

Author: Kristin Veighey

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